OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis, and provide a foundation for rational operations. METHODS The operations and prognosis of 102 primary gastric carcin...OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis, and provide a foundation for rational operations. METHODS The operations and prognosis of 102 primary gastric carcinoma patients with liver metastasis were studied retrospectively. RESULTS In gastric carcinoma patients with H1 metastasis who underwent a resection operation, the 6-month, 1- and 2-year post-operative survival rates were 61%, 42% and 7%. There was a statistically significant difference in survival between resected and non-resected patients （P=0.000） in gastric carcinoma cases with H2 metastasis, resection operations resulted in 54%, 16% and 8% respective survival rates, with no significant difference compared to patients not receiving a resection （P=0.132）. Gastric carcinoma patients with H3 metastasis who received a resection operation showed 25%, 13% and 0% respective survivals with no significantly better prognosis compared to the non-resected cases （P=0.135）. There was no statistically significant difference in survival between the cases with or without peritoneal metastasis （P=0.152）. CONCLUSION A resection operation provides a better prognosis for gastric carcinoma patients with H1 metastasis independent of peritoneal metastasis, but resection has no benefit for gastric carcinoma cases with H2 or H3 metastasis. Peritoneal metastases are not the significant influencing factor for the prognosis of gastric cancer with liver metastasis.展开更多
Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various compl...Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease.展开更多
AIM： To summarize the clinical experience of laparoscopic hepatectomy at a single center. METHODS： Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma （n = 39）, metastatic liver carcino...AIM： To summarize the clinical experience of laparoscopic hepatectomy at a single center. METHODS： Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma （n = 39）, metastatic liver carcinoma （n = 10）, and benign liver neoplasms （n = 29） underwent laparoscopic hepatectomy in our unit. A retrospective analysis was done on the clinical outcomes of the 78 patients. RESULTS： The lesions were located in segments Ⅰ （n = 3）, Ⅱ （n = 16）, Ⅲ （n = 24）, Ⅳ （n = 11）, Ⅴ （n = ii）, Ⅵ （n = 9）, and Ⅷ （n = 4）. The lesion sizes ranged from 0.8 to 15 cm. The number of lesions was three （n = 4）, two （n = 8） and one （n = 66） in the study cohort. The surgical procedures included left hemi-hepatectomy （n = 7）, left lateral lobectomy （n = 14）, segmentectomy （n = 11）, local resection （n = 39）, and resection of metastatic liver lesions during laparoscopic surgery for rectal cancer （n = 7）. Laparoscopic liver resection was successful in all patients, with no conversion to open procedures. Only four patients received blood transfusion （400-800 mL）. There were no perioperative complications, such as bleeding and biliary leakage. The liver function of all patients recovered within 1 wk, and no liver failure occurred. CONCLUSION： Laparoscopic hepatectomy is a safe and feasible operation with minimal surgical trauma. It should be performed by a surgeon with sufficient experience in open hepatic resection and who is proficient in laparoscopy.展开更多
A case with intracranial glioma after the surgery metastasizing to the spine was described. A 28-year-old female patient who underwent surgery and radiation therapy for glioma in the left frontal lobe and was diagnose...A case with intracranial glioma after the surgery metastasizing to the spine was described. A 28-year-old female patient who underwent surgery and radiation therapy for glioma in the left frontal lobe and was diagnosed as having extracranial metastasis to L2–L4 vertebral body by MRI, PET-CT and pathological examination. The clinical, imaging and pathologic features of the case are described and discussed.展开更多
Dermatofibrosarcoma protuberans(DFSP), the most common dermal sarcoma, is a low-grade, slow growing fibroblastic malignant neoplasm that most frequently affects middle aged adults and is characterized by a high local ...Dermatofibrosarcoma protuberans(DFSP), the most common dermal sarcoma, is a low-grade, slow growing fibroblastic malignant neoplasm that most frequently affects middle aged adults and is characterized by a high local recurrence rate and a low propensity for metastasis. Wide surgical resection or Mohs micrographic surgery(MMS) are the preferred approaches for localized disease, while radiation therapy is warranted for inoperable disease or for cases with positive margins where re-excision is not possible. DFSP is generally regarded as refractory to conventional chemotherapy. Treatment options for systemic disease were limited until the discovery of a unique translocation, t(17;22)(q22;q13)(COL1A1;PDGFB) found in a majority of cases. In recent years, imatinib, a PDGFβR, ABL and KIT inhibitor, has revolutionized systemic therapy in DFSP. In this review, we summarize the epidemiological, clinical, histological and genetic characteristics of DFSP and update the readers on its current management.展开更多
Background:The prognosis for patients with colorectal-cancer liver metastases(CRLM)after curative surgery remains poor and shows great heterogeneity.Early recurrence,defined as tumor recurrence within 6 months of cura...Background:The prognosis for patients with colorectal-cancer liver metastases(CRLM)after curative surgery remains poor and shows great heterogeneity.Early recurrence,defined as tumor recurrence within 6 months of curative surgery,is associated with poor survival,requiring earlier detection and intervention.This study aimed to develop and validate a bedside model based on clinical parameters to predict early recurrence in CRLM patients and provide insight into post-operative surveillance strategies.Material and methods:A total of 202 consecutive CRLM patients undergoing curative surgeries between 2012 and 2019 were retrospectively enrolled and randomly assigned to the training(n=150)and validation(n=52)sets.Baseline information and radiological,pathological,and laboratory findings were extracted from medical records.Predictive factors for early recurrence were identified via a multivariate logistic-regression model to develop a predictive nomogram,which was validated for discrimination,calibration,and clinical application.Results:Liver-metastases number,lymph-node suspicion,neurovascular invasion,colon/rectum location,albumin and post-operative carcinoembryonic antigen,and carbohydrate antigen 19–9 levels(CA19–9)were independent predictive factors and were used to construct the nomogramfor early recurrence after curative surgery.The area under the curve was 0.866 and 0.792 for internal and external validation,respectively.The model significantly outperformed the clinical risk score and Beppu’s model in our data set.In the lift curve,the nomogram boosted the detection rate in post-operative surveillance by two-fold in the top 30%high-risk patients.Conclusion:Our model for early recurrence in CRLM patients after curative surgeries showed superior performance and could aid in the decision-making for selective follow-up strategies.展开更多
A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,t...A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,though they may be judiciously considered for other sites of metastasis.To be considered for curative intent with surgery,patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant.Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability(so-called‘conversion’chemotherapy).While conversion chemotherapy in this setting aims to improve survival,the choice of a regimen remains a complex and highly individualized decision.In this review,we discuss the role of RAS status,primary site,sidedness,and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.展开更多
基金Foundation item:This work was supportedby National Natural Science Foundation(No.30471678)
文摘OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis, and provide a foundation for rational operations. METHODS The operations and prognosis of 102 primary gastric carcinoma patients with liver metastasis were studied retrospectively. RESULTS In gastric carcinoma patients with H1 metastasis who underwent a resection operation, the 6-month, 1- and 2-year post-operative survival rates were 61%, 42% and 7%. There was a statistically significant difference in survival between resected and non-resected patients （P=0.000） in gastric carcinoma cases with H2 metastasis, resection operations resulted in 54%, 16% and 8% respective survival rates, with no significant difference compared to patients not receiving a resection （P=0.132）. Gastric carcinoma patients with H3 metastasis who received a resection operation showed 25%, 13% and 0% respective survivals with no significantly better prognosis compared to the non-resected cases （P=0.135）. There was no statistically significant difference in survival between the cases with or without peritoneal metastasis （P=0.152）. CONCLUSION A resection operation provides a better prognosis for gastric carcinoma patients with H1 metastasis independent of peritoneal metastasis, but resection has no benefit for gastric carcinoma cases with H2 or H3 metastasis. Peritoneal metastases are not the significant influencing factor for the prognosis of gastric cancer with liver metastasis.
文摘Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease.
文摘AIM： To summarize the clinical experience of laparoscopic hepatectomy at a single center. METHODS： Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma （n = 39）, metastatic liver carcinoma （n = 10）, and benign liver neoplasms （n = 29） underwent laparoscopic hepatectomy in our unit. A retrospective analysis was done on the clinical outcomes of the 78 patients. RESULTS： The lesions were located in segments Ⅰ （n = 3）, Ⅱ （n = 16）, Ⅲ （n = 24）, Ⅳ （n = 11）, Ⅴ （n = ii）, Ⅵ （n = 9）, and Ⅷ （n = 4）. The lesion sizes ranged from 0.8 to 15 cm. The number of lesions was three （n = 4）, two （n = 8） and one （n = 66） in the study cohort. The surgical procedures included left hemi-hepatectomy （n = 7）, left lateral lobectomy （n = 14）, segmentectomy （n = 11）, local resection （n = 39）, and resection of metastatic liver lesions during laparoscopic surgery for rectal cancer （n = 7）. Laparoscopic liver resection was successful in all patients, with no conversion to open procedures. Only four patients received blood transfusion （400-800 mL）. There were no perioperative complications, such as bleeding and biliary leakage. The liver function of all patients recovered within 1 wk, and no liver failure occurred. CONCLUSION： Laparoscopic hepatectomy is a safe and feasible operation with minimal surgical trauma. It should be performed by a surgeon with sufficient experience in open hepatic resection and who is proficient in laparoscopy.
文摘A case with intracranial glioma after the surgery metastasizing to the spine was described. A 28-year-old female patient who underwent surgery and radiation therapy for glioma in the left frontal lobe and was diagnosed as having extracranial metastasis to L2–L4 vertebral body by MRI, PET-CT and pathological examination. The clinical, imaging and pathologic features of the case are described and discussed.
基金support from the NIHR Royal Marsden/ICR Biomedical Research Center
文摘Dermatofibrosarcoma protuberans(DFSP), the most common dermal sarcoma, is a low-grade, slow growing fibroblastic malignant neoplasm that most frequently affects middle aged adults and is characterized by a high local recurrence rate and a low propensity for metastasis. Wide surgical resection or Mohs micrographic surgery(MMS) are the preferred approaches for localized disease, while radiation therapy is warranted for inoperable disease or for cases with positive margins where re-excision is not possible. DFSP is generally regarded as refractory to conventional chemotherapy. Treatment options for systemic disease were limited until the discovery of a unique translocation, t(17;22)(q22;q13)(COL1A1;PDGFB) found in a majority of cases. In recent years, imatinib, a PDGFβR, ABL and KIT inhibitor, has revolutionized systemic therapy in DFSP. In this review, we summarize the epidemiological, clinical, histological and genetic characteristics of DFSP and update the readers on its current management.
基金supported by the Key Technology Research and Development Program of Zhejiang Province [No.2017C03017]the National Natural Science Foundation of China [81672916,11932017,81802750]+2 种基金the Natural Science Foundation of Zhejiang Province [LQ20H180014 to Y.Y.]the China Postdoctoral Science Foundation [2019M652117 to Y.Y.]the Natural Science Foundation of Zhejiang Province [LBY20H160002].
文摘Background:The prognosis for patients with colorectal-cancer liver metastases(CRLM)after curative surgery remains poor and shows great heterogeneity.Early recurrence,defined as tumor recurrence within 6 months of curative surgery,is associated with poor survival,requiring earlier detection and intervention.This study aimed to develop and validate a bedside model based on clinical parameters to predict early recurrence in CRLM patients and provide insight into post-operative surveillance strategies.Material and methods:A total of 202 consecutive CRLM patients undergoing curative surgeries between 2012 and 2019 were retrospectively enrolled and randomly assigned to the training(n=150)and validation(n=52)sets.Baseline information and radiological,pathological,and laboratory findings were extracted from medical records.Predictive factors for early recurrence were identified via a multivariate logistic-regression model to develop a predictive nomogram,which was validated for discrimination,calibration,and clinical application.Results:Liver-metastases number,lymph-node suspicion,neurovascular invasion,colon/rectum location,albumin and post-operative carcinoembryonic antigen,and carbohydrate antigen 19–9 levels(CA19–9)were independent predictive factors and were used to construct the nomogramfor early recurrence after curative surgery.The area under the curve was 0.866 and 0.792 for internal and external validation,respectively.The model significantly outperformed the clinical risk score and Beppu’s model in our data set.In the lift curve,the nomogram boosted the detection rate in post-operative surveillance by two-fold in the top 30%high-risk patients.Conclusion:Our model for early recurrence in CRLM patients after curative surgeries showed superior performance and could aid in the decision-making for selective follow-up strategies.
基金This research was funded in part by the NIH/NCI Cancer Center Support Grant[P30 CA015704(SAC)].
文摘A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,though they may be judiciously considered for other sites of metastasis.To be considered for curative intent with surgery,patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant.Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability(so-called‘conversion’chemotherapy).While conversion chemotherapy in this setting aims to improve survival,the choice of a regimen remains a complex and highly individualized decision.In this review,we discuss the role of RAS status,primary site,sidedness,and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.
